Policy responses and statements
- Name of organisation:
- Scottish Parliament: Health
- Name of policy document:
- Certification of Death (Scotland) Bill (SP
Bill 58) - Health and Sport Committee Call For Evidence
- Deadline for response:
- 18 November 2010
Background: The Health and Sport Committee launched
a public call for written evidence from all interested parties on the
general principles of the Certification of Death (Scotland) Bill. This
Bill was introduced in the Scottish Parliament by the Scottish Government
on 7 October 2010.
The Policy Memorandum which accompanies the Bill states that its main
objectives of the Bill are to —
- Introduce a new system in Scotland for the scrutiny of medical
certificates of cause of death;
- Create the post of medical reviewer and senior medical reviewer,
whose functions will be to review for accuracy the certificates referred
- Where a person has died outwith Scotland and the body is to be
cremated in Scotland, medical reviewers will determine whether it
is safe to cremate the body. They may also instruct a post-mortem
in such cases from outwith the UK if no cause of death is available;
- Provide for the form of medical certificates of cause of death
to be amended to show additional relevant medical information to
indicate, for example, whether it is safe to dispose of the body
by cremation, and
- Make it an offence to dispose of a body or body parts without authorisation.
Call for written evidence:
The Committee invited evidence from individuals as well as from organisations
and professional bodies. The Committee intends that evidence received
will inform its consideration of the Bill at Stage 1.
The Committee invited views on all aspects of the Bill. Responses
were invited on any or all of the following points -
- Do you agree or disagree with the general principles of the Bill?
- Do you agree with the proposed changes to the system of death
certification in Scotland?
- Do you agree with the proposed creation of a system of Medical
- Do you have any comments on the costs identified in the Financial
- Are there any other comments you wish to make on the Bill?
Scottish Parliament: Health Committee
Certification of Death (Scotland) Bill
The Royal College of Physicians of Edinburgh (the College) is pleased
to respond to the Scottish Parliament’s consultation on the Certification
of Death (Scotland) Bill.
The College supports moves to streamline processes and reduce cremation
costs. Answers to the consultation questions are set out below.
- Do you agree or disagree with the general principles of
The College agrees with the policy aims underpinning the Bill, namely
- introduce a single system of independent, effective scrutiny
applicable to deaths that do not require an investigation by the
- improve the quality and accuracy of the medical certificate of
cause of death form; and
- provide improved public health information and strengthened clinical
governance in relation to deaths.
The College also supports moves to improve the efficiency and cost
of death certification for the majority of families and the removal
of inconsistencies between the processing and scrutiny of cremations
- Do you agree with the proposed changes to the system of
death certification in Scotland?
In general, the College supports the proposed changes to provide for
a single signatory to certify death in Scotland.
However, the College has several concerns including:
- the need for a threshold test and shorter time limit in relation
to interested person reviews; and
- the impact of delays caused by random reviews of death certificates
Interested person reviews
It is noted that the proposed system appears to require the Medical
Reviewer to review a death certificate where requested by an interested
person, unless the application is vexatious. It may be difficult
for the Medical Reviewer to determine whether an application is vexatious,
meaning that the Reviewer may end up reviewing the majority of applications
he or she receives. This could involve applications from persons
who don’t “like” the cause of death noted by the
To ensure efficiency and fairness, the College considers that there
a need for the introduction of a threshold test describing the circumstances
within which an interested person can seek a review. For example,
the person could be required to demonstrate that they are concerned
that the cause of death listed may not represent a reasonable conclusion
as to the likely cause of death and/or a belief that other information
contained in the certificate may be incorrect. An appeal mechanism
would also need to be built into such a system.
Consideration could be given to whether such a test should be incorporated
in the legislation or introduced as guidance after the passage of the
There is also concern that the 3 year time limit within which an interested
person may seek a review is too long a time period to allow a meaningful
review to take place.
Concern for families
The College is concerned about the impact of intervention and delays
where deaths are randomly selected for scrutiny pre-registration.
It is noted that the Government anticipates that scrutiny will have
minimal impact on the scheduling of funerals, and that, in certain
circumstances, families will be able to request that the registration
of the death takes before the review is completed. Registration
will only be allowed where the Medical Reviewer is satisfied that the
circumstances of the case justify registration and there are no obvious
indications that the medical certificate is not in order.
It may be extremely distressing for families to have someone intervening
where the family perceives there is no issue and where they are not
eligible for the expedited registration procedure.
Early consideration must be given to who will be responsible for explaining
to families the possibility that the certificate may be selected for
review or the subject of a review application from an interested person,
and at what point this should occur. That person must be appropriately
trained and readily accessible to the family. Once a certificate
is selected for review, the process and timescales should be explained
to affected families in person.
Delays during reviews must be kept to a minimum and timescales should
be set out in guidance accompanying the legislation. It is imperative
that the process is speedy, transparent and properly explained to avoid
undue distress to bereaved families.
- Do you agree with the proposed creation of a system of
- Do you have any comments on the costs identified in the
The College welcomes proposals to replace cremation fees with a modest
certification fee for both cremations and burials to fund the running
costs of the new certification system. This will reduce costs
for the majority of families and offers a more equitable system.
- Are there any other comments you wish to make on the Bill?
The College is supportive of moves to include more medical information
on death certificates regarding surgical implants and public health
risks, which should also improve statistical recording of such information. The
College welcomes the General Register for Office’s proposed inclusion
of the Community Health Initiative (CHI) number on the form.
In order to improve the accuracy of death certificates, the College
recommends that a doctor of Specialist Registrar level or higher should
always be involved in the issue of a certificate.
The College acknowledges that legislative amendment cannot prevent
Shipman-style cases, and should be driven instead by broader patient
Dr A D Dwarakanath FRCP Edin
Royal College of Physicians of Edinburgh
9 Queen Street
17 November 2010
Copies of this response are available from:
Royal College of Physicians of Edinburgh,
9 Queen Street,
Tel: 0131 225 7324 ext 608
Fax: 0131 220 3939
[17 November 2010]